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Ohio State Medical Society 

Columbus, June lo, 11,12, 1873. 



REPORT ON 



ffi^sanmnid mid ffrnnkenness. 

By D. a. morse, M. D. 

Formerly Lecturer on Legal Medicine and Lnsanity. 









Dipsomania and Drunkenness 

BY 

D. ^. MORSE, M. D., 

Formerly Lecturer upon Legal Medicine and Insanity. 



te 



:^ * ^ * '^/a DiPSOMANiE nest pas davantage un etat mental 
morbide special : elle appartient au mmnie groupe de symptomes que la 
boulimie, le pica, la malacia, le degout pour toute espece d'alif?ients, 
et comme-eux depend de la gastralgie; ce besoin dit irresistible de 
boire des alcooliques est le resultat d^une perversion de la sensibilite 
gastrique, mais n'est certainement pas une monomanie." De 
Vetat mental dans Valcoolisme aigu et chronique, par Le Dr. Au- 
guste Voisin. Page ^^-(Faris 1894.) 









' 7 



DIPSOMANIA AND DKUNKENNESS. 

BY 

D. A. MORSE, M, D., 

Formerly Lecturer upon Legal Medicine and Insanity. 



/« <Aerc cr Dipsomania? What is its nature^ Is it o. form of Insanity f Is 
it a Monomania? What distinguishes it from Common Drunkenness? How 
is it related to Delirium Tremens ? What is the Mental State ? What degree 
of Legal Responsibility is determined thereby ? To what extent can drunken- 
ness be alleged as an excuse for crime? How far will it relieve from Legal 
Responsibility ? 

What ^Uests" shall we apply to determine, with the Drunkard, insanity^ 
and as a consequence irresponsibility, or the contrary, full Legal Responsi- 
bility! 



Gentlemen : 

Such are the questions into which our subject naturally 
resolves itself, and which we desire to propound to-day for 
your consideration — questions that in all probability will 
not be of equal interest to every one, yet questions that 
should interest every medical man who is liable to be called 



4 Dipsatnanta and Drunkenness. 

as an expert, — that should be fully understood by every well 
informed man ; questions that in recent trials in !N'ew York, 
and elsewhere, have demanded great labor and a profound 
examination of their claims, in a medico-legal point of 
view, with reference to the facts constituting the several 
cases in which they have been alleged as a means of defense 
— as an excuse for crime that immunity from punishment 
might be afforded thereby. 

The Transactions of this society announce the subject of 
my Report : Insanity. That which the Report was intended 
to present, and which I worked up for this occasion, was a 
consideration from a medico-legal stand-point, of the subject 
of Criminal Besponsibility; discussing the relations of or- 
ganization to responsibility ; the ideal standard that deter- 
mines full legal responsibility ; the relation of moral deprav- 
ity to the so-called moral insanity of writers. 

For this purpose, and other applications of it {as my 
work, "Morse's Medico-Legal Criminal Procedure: The 
Law, Evidence, and Practice "), I have gathered from ev- 
ery source possible, in this country and Europe, material 
which has proved to be a very considerable amount. Erom 
the great length to which it was necessary to extend the 
paper, that full justice might be done to the subject, I deter- 
mined last week to present a paper upon a part only of the 
subject—to discuss the monomanias, the relation they sus- 
tain to other forms of insanity, whether there is in reality 
an insanity without delirium, and if so the legal consequen- 
ces. To do this required more time than I would be able to 
give it. I therefore concluded to confine my paper to one 
form of disease, alleged to be a monomania, hoping thereby 
to better exhaust the points presented, and will, if it is 



Ohio State Medical Society. 5 

thought desirable, at our next meeting, discuss the monoma- 
nias in all their various relations, but chiefly with reference 
to the points mentioned above, and mania with homicidal 
tendencies — instinctive or reasoning mania; the relation 
of instinct to the mental faculties, and the part it plays in 
the instinctive or impulsive forms of insanity. 

In the investigation of our subject I propose to follow 
the injunction of Aristotle, to first determine whether a 
fact alleged he in reality a fact, before an attempt is made to 
explain it, to show why it is or the consequences of it. 

In medicine, perhaps more than in any other science, are 
theories presented to explain supposed conditions, when in 
reality the conditions explained never existed. 

Writers upon logic and metaphysics, to illustrate this 
principle, cite the anecdote related of King Charles II. of 
England, who submitted to a learned society for explana- 
tion the question why it is that a jar containing water 
when a live fish is placed therein weighs no more than be- 
fore, but when a dead fish is thrown in the weight is equal 
to the sum of the respective weights of fish, water, and jar. 
Several days' discussion followed, and many learned and 
apparently satisfactory explanations were given of the ques- 
tion, but at length a member of the society called attention to 
the suggestion of the old Grecian philosopher, and suggest- 
ed that the experiment be tried to determine first whether 
the fact assumed was a fact. A pair of balances were 
brought in, the experiment tried, when lo ! to the dismay 
and mortification of all it was found the weight was the 
same whether the fish was alive or dead. 

In my humble opinion many theories based upon the sup- 
posed existence of particular conditions of insanity, presented 



6 Dipsomania and Drunkenness. 

to explain the legal consequences thereof, are no better 
founded, and bear as much relation to the truth, as do to a 
consideration of man's free moral agency the questions, 
"How many angels can stand on the point of a needle?" or, 
"Should Christianm en wear sewed boots?" In this appli- 
cation of legal relations, theoretically, the an sit, whether it 
be so — whether the condition exists has not been first de- 
determined. 

We, keeping this in mind, will endeavor to — 

I. Ascertain if there is a disease entitled to the name of 
a monomania, which disease has be^n named dipsomania, 
and other terms expressive of the views of the person writ- 
ing upon it, as methomania, furor bibendi, oinomania, ana- 
methusis, with Bruhl-Cramer and other Germans, trunk- 
sucht, with the French /o^^e dHvresse, folic tronsitoire d'ivresse, 
etc., etc. 

II. Its Nature. 

III. The Mental State. 

lY. The degree of Legal Responsibility. 

To sustain our first division — whether there is a dipso- 
mania — we must interrogate every possible source of evidence 
that we can cause to respond. The grounds of our belief 
and confidence in these sources should be such that no 
doubt should remain that that which we seek to establish is 
not thereby confirmed. These sources of evidence are few 
in number. The sources, the ''best evidence" the subject 
admits of, may be divided into three classes. 

1. The voice of authority. 

2. The evidence of the party alleged to be a dipsomaniac. 

3. Our own experience and judgment. 



Ohio State Medical Society. 7 

1. The voice of authority. We shall present upon the sub- 
ject of dipsomania the views of those authors whose works 
have become classic. It is presumed that authors who pos- 
sess cultivated minds — who have traveled the same road we 
are about to travel — who from long experience are compe- 
tent and careful observers, and are able to make inferences 
from many facts, keeping them all before the mind — not 
viewing them from one stand-point alone — who, unbiased, 
clearly define their views, will convince of that whereof 
they speak. 

The first author we desire to quote is the first writer who 
called attention to the condition in question. Dr. Salvatori 
read before a medical society at Moscow, December 8, 1817, 
a memoir upon what he called by several names. His lan- 
guage is as follows : " The malady to which I desire to 
call your attention has thus far been banished from practi- 
cal nosology ^ t- ^ \ wish to speak of the habit of 
" drinking in an excessive manner of wine and strong drink, 
and of a special disease the offspring of it, — that which we 
may call furor bibendi, or, to employ a Greek word, oinoma- 
niaJ* In another paragraph he terms it anamethiisis, which 
means repeated drunkenness (ivresse reiteree). 

K-ayer in 1819 proposed to replace these terms by that of 
delinum tremens — a word coined by Dr. Sutton in 1813. 

Dr. Salvatori (quoted by Foville fils) in his^ work men- 
tioned above, gives the following description of an attack of 
dipsomania, which I translate from the French. Salvatori 
says : " These are the principal symptoms : ^ In the morn- 
ing before eating there is nausea, languor, vertigo," frequent 
eructations ; there is a much more abundant secretion of 
saliva than ordinary, trembling of the limbs, general 



8 Dipsomania and Drunkenness. 

malaise. After some days passed in this way the appetite 
vanishes, sleep is short and disturbed, life appears intoler- 
able. The image of the drink preferred presents itself then 
to the mind of the unfortunate; it so occupies his mind 
that he can receive no other impression, nor take^ heed to 
the advice of friends, or of their tears. The unfortunate 
(malade) feels himself forced of necessity to drink, and he 
says that if they do not furnish him drink he will become 
insane. Under the influence of this terrible impulse he 
places the lips to the cup and intoxicates himself at the first 
draught. The premonitory symptoms then disappear, the 
nausea and melancholy are alike dissipated, the physical 
force returns, the pulse is rapid. During two or three days 
the mind is cheerful, then if liquor is wanting there is great 
irritability. The sight is now troubled, speech difficult, the 
mind really alienated, the melancholy returns, the victim 
complains of his fate, the pulse is spasmodique. The intoxica- 
tion is then at its height. It produces vomiting of a glu- 
tinous matter — acid and almost corrosive. The individual 
detests alcohol and returns to reason only to accuse him- 
self. He falls into a state of languor, has during his sleep 
profuse sweats, which exhale the odor of alcohol. He is af- 
fected by pains in the stomach, diarrhea, and tenesmus. 

" I have never seen the duration of an attack of this spe- 
cies exceed fifteen days. Sometimes it ceases the sixth or 
ninth. During the interval of sobriety which follows, all 
kinds of liquor inspire absolute disgust. I have seen many 
who after an attack of fifteen days remain sober during 
another fifteen ; others abstain during a month and even 
half a year." 

Dr. Erdraan, who remained a long time in Russia, has 



Ohio State Medical Society. 9 

given an account of this singular disease. Marc has trans- 
lated it into French from a German journal. I translate 
it from Marc'p/ jDe la Folie consideree dans ses Bapports 
avec les questions medico judiciaries, Paris, 1840. Dr. Erd- 
man says: '* There is a particular form of dipsomania 
known in Russia under the name of Sapoi, which merits 
mention. It consists in a periodic propensity to.abuae 
spirituous drinks, a propensity that even men very highly 
endowed with reason can not conquer. These drinkers ab- 
stain during several weeks, or months, from their cups, 
with the firm resolution to drink no more ; they show not 
otherwise the desire; but little by little they experience a 
malaise, a disgust for all occupation, even for all recre- 
ation, a want of appetite, and at length a melancholy bor- 
dering on despair. Then shows itself anew a most ardent 
thirst for strong drink. The victim can no longer content 
himself: his temperance resolution is forgotten. He begins 
to drink, becomes intoxicated, continues to drink, — some- 
times without taking food — and falls at last into a state of 
drunkenness, in which condition he remains for several 
days, and which at times is accompanied with maniacal de- 
lirium. Then the desire for strong drink ceases, and the 
individual falls into a kind of apathy, v^hich sooner or later 
ceases. 

"From this moment the liquor inspires disgust and the in- 
dividual recognizes all the bad consequences of the vice of 
drunkenness, and soon makes a firm resolution to drink no 
more; but it is in vain, for, sooner or later, the same symp- 
toms which accompanied the desire for strong drink reap- 
pear, and the same scene is renewed. This irresistible pro- 
pensity for drunkenness is observed, it is true, the most fre- 



10 Dipsomania and Drunkennes. 

qnently among the inferior classes; but it is not rare in the 
higher ranks of life. I recollect a man of a cultivated mind 
and endowed with the best qualities of heart. After an in- 
sanity caused by drunkenness, for which I treated him, I 
made some remonstrances the most serious upon the con- 
sequences of his excesses. From that moment he ceased to 
drink, remained during two months faithful to his resolu- 
tion of temperance, and published everywhere that to me 
he owed his recovery. But soon he commenced to drink 
more than ever. My most active efforts in his behalf were 
vain. I had represented to him well his course and that it 
would end in his death. He replied that he much preferred 
death to the abandoning of his course. Sometime after he, 
being in a normal state, conceived the idea of correcting 
himself; but this resulted as before, and he being attacked 
with a pernicious fever, succumbed. 

"Periodic dipsomonia does not always terminate so mourn- 
fully, but often it is prolonged during many years." 

Roesch gives the symptoms of dipsomania, but divides it 
into two varieties — continuous Siud periodic. The main symp- 
toms he gives are depression of spirits or melancholy, sleep- 
lessness, agitation, nausea, and constipation. He says: 
" Doubts are everywhere raised against the existence of pe- 
riodic drunkenness (dipsomania), nevertheless, they have 
been completely removed, as Henke well demonstrated, and 
above all by the excellent work of Erdman. Erdman, dur- 
ing a long sojourn in Russia, not only has seen very often 
the ordinary effects of strong drink upon the organism, — even 
to delirium tremens — but besides has observed that periodic 
drunkenness which ends by becoming a true mental mala- 
dy, in which the man loses his free will and is no more in a 



Ohio State Medical Society. 11 

Btate to resist his propensity than is a female attacked with 
nymphomania. But Henke proved that this morbid con- 
dition exists in the rest of Europe, especially in Germany." 
{Annales d'hygiene et de medicine legale, T. XX. p. 50-63, 
1838.) 

In 1822 Pierquin, of Montpelier, published an observa- 
tion similar to and confirming those cited. 

In 1827, Chambeyron published a translation of Hoff- 
bauer, with notes by Esquirol. One of these notes contains 
the following : '* In some cases, observation demonstrates 
that the abuse of intoxicating drinks are the first symptoms, 
or better, the most prominent symptoms of a commencing 
insanity. * * * ^^^^ persons attacked with this variety 
of insanity obey a force which it is not in their power to 
resist. The motives the most powerful, the resolutions and 
promises the most solemn, the disgrace and danger to which 
they are exposed, the physical pains which attend them, 
the punishment with which they are threatened if they 
correct not their ways, the prayers, supplications of 
friends, nothing can deter them from the mournful propen- 
sity. These individuals, are they not true monomaniacs? 
If we observe them with care we will find in them all the 
features that characterize partial insanity." 

This would seem to confirm the views of those who 
maintain the existence of a special form of insanity — a 
monomania. 

Tardieu {Manuel de Pathologie et de Clinique Medicales) 
uses this language : " The monomania of intoxication (dip- 
somania) presents the same character as the other monoma- 
nias without delirium, and has not a less real existence; it 
ifl even more frequent than the greater part of them. These 



12 Dypsomania and Drunkenness. 

persons of whom the habits of life are the farthest sepa- 
rated from debauchery and drunkenness show a kind of 
physical and moral weakness, in which they are gradually 
exhausted, delivering themselves up to the abuse of alcoholic 
drinks, and giving way soon to an impulse they have not 
power to resist. The motives the most powerful, the res- 
olutions of greatest force, the promises the most solemn 
can not deter these unfortunates from their deplorable tend- 
encies. At times this desire is, as we may say, periodic, 
and reappears during several years at the same time. In 
the intervals the afflicted remain sober; some even have a 
great repugnance to all fermented liquors, and drink only 
water. The critical ages of man and woman are not with- 
^ out influence upon the development of this disease." ( P. 
558, Lia Monomanie de LHvresse, Dipsomanie.) 

Marce, Traite Pratique des Maladies Mentales^ p. 387, un- 
der the name, impulsive monomanies, treats of Dipsomania. 
He says, " We designate under the name of dipsomania a 
particular form of instinctive monomania, which consists 
in an irresistible desire to drink alcoholic liquors." 

To accept all that these writers say it is necessary to admit 
the existence of a monomania — of an insanity without 
delirium. 

Marc recognizes the existence of the disease in question, 
but does not define or describe it. His views upon the 
nature of dipsomania we will give under the proper divis- 
ion of our subject. 

Greisinger, Traite des Maladies Mentales.^ p. 204, says: 
"Dipsomania, properly so called, or intermittent and pe- 
riodic drunkenness, is rather a symptom than a cause of 
periodic insanity. Thus there are some cases, — I have myself 



Ohio State Medical Society. 13 

observed a few — where, simultaneously with other phenom- 
eoa of nervous origin, headache, prostration, pains in the 
epigastric region, a state of moral and general malaise, we 
see supervene a certain degree of melancholy, to which 
soon succeeds agitation. The individual thus affected be- 
gins then to frequent drinking-places, and to drink to in- 
toxication during several successive days. During these 
times the drunkenness attains ordinarily the proportions of 
a veritable fit (acces) of mania; then the individual falls 
into a profound apathy and experiences an excessive dis- 
gust for alcoholic liquors. Ordinarily these attacks reap- 
pear a number of times. In order to appreciate well those 
facts relating to dipsomania, it is necessary to ascertain 
carefully whether the attack was preceded or not by a pe- 
riod of melancholy, if the individual offers evidence of an 
hereditary predisposition, and if on the contrary he has a 
taste for liquors. In this last case it is very rare that this 
desire for drink, that the attack of dipsomania, is the 
result of a morbid condition," 

Orjila, Legale Medecine T. I. p. 420, speaks of ordinary 
delirium tremens, then adds further, " The German physi- 
cians have described another variety of insanity, or of de- 
lirium tremens, characterized in all its course by an irresist- 
ible desire to drink alcoholic liquors, by delirium, trembling, 
furor, by horrible abuse if the desire is not satisfied, or if 
the individual is not deceived by some substitute. This 
dipsomania — that is the name they give to this variety of 
delirium — can last some days or weeks, may be continuous 
or intermittent, terminate by a return to health or in incur- 
able demency. In all these cases, the man should not be 
held responsible for his conduct; the drunkenness is not 

3 



1 4 Dipsoinania and Drunkenness. " 

voluntary, it is the result of a true disease ; to the crimiuai 
as well as to man in civil life we ought to apply, it seems 
to me, the laws relating to the insane." 

Casper, Traite Pratique et Clinique de Medicine Legale, T. 
I. p. 368, says, under the subject of maladies mentales, of 
dipsomania, '' Among the men who drink, some, and it is 
the greatest number, have not lost all control over them- 
selves; they can yet subdue their vices; they drink often 
without becoming intoxicated, but nevertheless, altering 
more and more their nutritive functions, they end by suc- 
cumbing to the consequences of alcoholic intoxication. 
Others are attacked with that peculiar affection we call the 
delirium tremens (le delire des buveurs) ; this is nothing else 
than a periodic mania. Others again fall into a state of 
mania, very peculiar, which though rare, is beyond doubt 
not less to be admitted, that which we call dipsomania. To 
the names of Bruhl-Cramer, Erdman, Clarus, Fuchs, Rade- 
macher, to the authority of all these I can add my own 
personal observations," He then gives cases in detail to 
confirm his views and illustrate them. 

Dagonet, Traite des Maladies Mentales, p. 410-11, confirms 
the views of other writers and quotes from Esquirol, Marc, 
Henke, and Fuchs, to support them. He says, "the mal- 
ady appears by periodic attacks (acces) — that the affected 
may show regular habits and be sober, but that under the 
influence of some cause, physical or moral, the fit manifests^ 
its premonitory symptoms. The most prominent symptom 
or feature is- an irresistible propensity to drink alcoholic- 
liquor. 

JBruhl- Cramer has been referred to several times. He 
disputed the validity of the claims of Salvatori to priority 



Ohio State Medical Society. 15 

of description of dipsomania. It is singular, that two 
physicians of the same city should fail to receive the credit 
due them respectively — it is more singular that two years 
after Salvatori had read before a medical societ}^ his article 
upon di[>somania, Bruhl-Cramer should claim to be first to 
describe the disease. He termed the disease trunkrsucht. 
Hufeland wrote an introduction to the work and intro- 
duced first the word dipsomania from the Greek dijjsa, thirst, 
and mania. 

A number of other writers might be cited who confirm 
the views already given of the existence of a dipsomania. 
"We will leave the Continent and notice a few English works, 
then one or two American. 

Among the British w^riters, Taylor may be mentioned as 
a prominent medico-legal writer. He recognizes and ad- 
mits the existence of a dipsomania, but treats only of the 
legal relations. 

Forbes Winslow has described the disease in the Journal 
of Psychological Medicine^ 2d series, vol. ii., p. 483, in 1?^62, 
in a review of a reprint of the work of Salvatori. Wins- 
low quotes Prof. Christison, agreeing with him in saying 
that the work of Salvatori is the best that he is acquainted 
with npon the subject of dipsomania. 

Backnill and Tuke^ Manual of Insanity, p. 218, confirm 
the views of those who maintain the existence of a dipso- 
mania. They regard as the prominent feature of the dis- 
ease the irresistible propensity to drink. 

Of American writers we find some who mention dipso- 
mania — others who completely ignore it. Beck only hints 
at it; Wharton and Stille are silent upon the subject, al- 
though they have a perfect mania for manias. Ray con- 
tains a discussion, chiefly relating to the legal relations of 
the subject. Other views are given on pages 488-9 of his 



1 6 Dipsomania and Drunkenness. 

work, but which are alreodj quoted, in those giveu of 
Esquirol, Marc, &c. The work contains nothing new upon 
the subject, but is valuable in that it brings together the 
views of others in an original manner. 

We might present an innumerable number of views con- 
tained in medical journals, dictionaries, &c., but it would 
add little to the value of the article — they being mere reit- 
erations of the views long since put forth by classic 
writers. 

2. The Existence of Dipsomania as Proved by the Evidence 
of the alleged Dipsom.aniac. MclSTish, p. 163, Anatomy of 
Drunkenness^ relates the conversation held with a dipso- 
maniac, with whom he remonstrated. The dipsomaniac 
replied: "My good friend, your remarks are just; they are 
indeed too true, but I can no longer resist temptation. If 
a bottle of brandy stood at one hand, and the pit of hell 
yawned at the other, and I were convinced that I would 
be pushed in as sure as I took one glass, I could not refrain. 
You are very kind ; I ought to be grateful for so many 
kind, good, friends, but you may spare yourselves the 
trouble of trying to reform me; the thing is out of the 
question." 

The books are full of like cases — but it is very difficult 
to say how much reliance can be put in the word of these 
men. Destitute of all moral principle, many of them have 
no regard for truth, honor, or even common decency. The 
old Adam of man's fallen nature forms in all these cases a 
strong element. Drink they ivilly their own desires being 
above all else, declaring that they '^ would drink if the devil 
stood over them," or as another one said to me a few years 
since: "If a jug of whisky stood at the depot, (that is, half 
a mile off,.) and there was a row of cannon constantly firing 



Ohio State Medical Society. 17 

from each side of the way, across it, I would risk my life 
to get the whisky." A fellow said to me while I was en- 
gaged upon this paper that he " wished I could give him 
something to make him decent." He had been drinking 
constantly for three weeks — his father was a drinker — the 
son inheriting a moral nature of a very low grade — with an 
unremitting thirst for drink, laziness, and a general state of 
good-for-nothingness. His passions were never restrained, 
nor his desires quenched, but he was reared simply to be a 
curse to both society and his friends. 

Many men may be seen in every community where liquor 
has been drank for several generations, who declare that 
they are unable to refrain from drink — yd they do for months 
when it is to their interest to do so ; as when the prospect of a 
wealthy bride, or other consideration is presented. They all 
declare that they are unable to withstand the sensation — 
the something which impels them to drink. Before they 
have drank to such an extent that brain and nerve disease 
are developed to a degree sufficient to dethrone the Will, 
they can in nearly every instance pause — even if the dis- 
ease, or rather vice, is inherited. But too often they have 
no desire to pause; they declare in one breath that they are 
going to end their drunkenness, that they do not wish their 
children to grow up knowing their father was a drunkard, 
and with the next breath demand more liquor and drink to 
drunkenness — turbulent, boisterous, a terror to all peace- 
able citizens, thej^ continue on until death removes them 
out of the way — leaving if they have children, offspring 
from which the various classes of idiots, insane, paupers, 
and criminals of all grades may be developed. 

3. With this vast array of evidence, the accumulated 
wisdom, experience, and labor, of men devoted to mental 
science, are we convinced that a condition exists which is 



18 



Dipsoi7ia7iia a7id Drunkenness. 



truly a dipsomoiiia — a mania for drink? Does the experi- 
ence and judgment of each one confirm the views present- 
ed? We have examined many authors — not one dissents 
from the assertion that there is a dipsojnania. The only dif- 
ference of opinion is concerning its nature — the degree of 
mental derangement — whether it is a mental disease, or 
only a physical condition, and the mental phenomena but 
symptomatic. As we shall endeavor to show in our paper 
upon the monomanias^ that there are certain physical con- 
ditions common to all these forms of disease, alleged to be 
insanity — we shall not exhaust the subject at present lest 
we destroy the interest in our paper, 

II. The Nature of Dipsomania is set forth by Marc as 
follows: "The dipsomania that some writers have called 
intermittent, and which to my mind is the result of a vicious 
habit, without any other cause than lohat idleness, sensuality, 
imitation and dissoluteness of morals have contributed to 
it." His original language can not be exactly expressed in 
English, I have given the sense of it. It reads: ^'la dipso- 
manie que quelques auteurs ont appele^ intermittente, et qui, a 
mon avis, est la suite dhme habitude vicieuse, sans qu^aucune 
autre cause que la paresse, la sensualite, Vimitation et la disso- 
lution des moeurs y aient contribueJ' 

Koesch says, memoir, p. 335, "The moral state of a man 
habituated to drink, or as expressed by Clarus, of a dipso- 
maniac, is assuredly not normal, as I have above declared. 
ISTevertheless, as a degeneration of morals, and of a nature 
that accompanies, not a real disease of the mind, and which 
hinders not the man from distinguishing the just from the 
unjust (good from evil), and from preserving some empire 

■^Appointed to report at Ohio State Medical Society, Toledo, June, 1874, 

upon MONOMANIA. 



OJiio State Medical Society. 19 

over himself, responsibility is not modified, and for grave 
reasons is not abolished, the dipsomaniac, as all other im- 
moral Dien, is responsible for the actions he commits when 
not drunk." 

We quote this to shovr that this eminent writer did not 
raise dipsomania in the rank of mental diseases, above 
common drunkenness; that while he admits the existence 
of the disease, he regards it rather as a cice than a disease 
worthy of the rank of true insanity. 

According to Erdman, "Dipsomania ought to be consid- 
ered as a mental affection, with absence of free will, and 
which can be compared with some reason to the uterine 
furor." 

Tardieu^ speaking of the nature of dipsomania, says, "It 
is certainly very difficult to trace the line which separates 
the monomania of drunkenness from the debauchery which 
results from a violent passion and a vicious impulse. Some 
excellent minds are not disposed to see in dipsomania a 
true partial insanity, — (H. Royer Collard). Whatever it 
may be we can not refrain from remarking, that in all cases 
this instinctive depravity delays not to result in a weak- 
ening and derangement of the intellectual faculties which 
degenerates often into general delirium. Sometimes the 
unfortunate and disgraced, despairing of their power to 
conquer the desire which impels them, end their days by a 
violent death." 

Dr. Tuke, Manual, p, 218, says of the nature of dip- 
somania: "This is a form of mental disorder, which, in an 
espeeial manner, requires to be discriminated from what 
may be termed a mere physiological condition, in which 
the human animal chooses to indulge in alcoholic bever- 
ages to excess. On the one hand, the admission of this 
disease into the department of mental pathology, does not 



20 Dipsofuania and Drunkenness. 

need to make us conclude that there is no such thing as in^ 
temperance withf»ut disease; and on the other, the fact that 
the abuse of alcoholic drinks has oftentimes no disease to 
plead in its excuse, must not lead us to the opposite extreme 
of denying that a truly diseased cerebral condition may ex- 
ist, the result of which is inebriety. How then shall we 
distinguish the two conditions, when the result — intemper- 
ance — is the same in both ? 

''First — by observing whether there are any symptoms 
present which can be referred to primary disorder of the 
nervous system, that is to say, other symptoms than those 
which as in ordinary drunkenness can be readily accounted 
for by the prolonged indulgence in alchoholic drinks. The 
family psychological history, again, is of great importance. 
Cases in which an insane parent has a drunken son, point 
strongly, of course, to disease. The development of the 
appetite for stimulants in early life is another indication in 
the same direction. But, to come more closely to the cir- 
cumstances attending the habit itself. The prominent 
feature of this propensity is its irresistibility; the thirst for 
drink is the tyrant which overbears all the higher emotions 
and blindly leads the oinomaniac to a course against which 
his reason and his conscience alike rebel. 

''^Dt. Hutchinson was among the first to draw special at- 
tention to this disease. After observing that there are in- 
dividuals who, at the festive board, invariably become 
excited, if not intoxicated, but are otherwise habitually 
sober, and in the course of a year drink much less than 
others who never appear to be under the influence of stim- 
ulants, and that others indulge in their potations in a reg- 
ular manner and daily consume a larger quantity of liquor 
than is consistent with good health and sobriety, he proceeds: 

"All these, however, possess self-control, and can at any 



Ohio State Medical Society. 21 

time refrain from stimulants ; but those afflicted with the 
disease can not do so, however convinced they may be of 
the impropriety of yielding to their propensity, or how de- 
sirious they may be to subdue it. 

" The disease appears in three forms, — the acute, the 
periodic, and the chronic. The acute is the rarest of the 
three. We have seen it occur from hemorrhage in the pu- 
erperal state, in recovery from fevers, from excessive vene- 
real indulgence, and in some forms of dyspepsia. 

'•^ The 'periodic or paroxysmal form is much more frequent 
than the acute. This is often observed in individuals who 
have suffered from injuries of the head; females during 
pregnancy, at the catamenial period and afterwards, and in 
men whose brains are overworked. Like the form about 
to be mentiqned, it is frequently hereditary, being derived 
from a parent predisposed to insanity, or addicted to in- 
temperance. In such cases the probability of cure is very 
small. The individual thus afflicted abstains for weeks or 
months from all stimulants, and frequently loathes them 
for the same period. But by degrees he becomes uneasy, 
listless, and depressed, feels incapable of application, and 
restless, and at last begins to drink till he is intoxicat- 
ed. He awakes from a restless sleep, seeks again a repe- 
tition of the intoxicating dose, and continues the same 
course for a week or two longer. Then a state of ap- 
athy and depression follows, during which he feels a loath- 
ing for stimulants, is the prey of remorse, and regrets bit- 
terly his yielding to his malady. This is followed by fresh 
vigor, diligent application to business, and a determined 
resolution never again to give way. But alas! sooner or 
later the paroxysm recurs, and the same scene is re-enacted; 
till ultimately, unless the disease be checked, he falls a vic- 
tim to the physical effect of intemperance, becomes maniacal 



-- Dipsomania and Drunkenness. 

or imbecile, or affected with the form of the disease next to 
be mentioned. 

" Of all the forms of oinomania the most common is the 
chronic. The causes of this are injuries of the head, dis- 
eases of the heart, hereditary predisposition, and intemper- 
ance. This is by far the most incurable form of the malady. 
The patient is incessantly under the most overwhelming 
desire for stimulants. He will disregard every impediment, 
sacrifice comfort and reputation, withstand the claims of 
affection, consign his family to misery and disgrace, and 
deny himself the common necessaries of life to gratify his 
insane propensity. In the morning morose and fretful, dis- 
gusted with himself and dissatisfied with all around him, 
weak and tremulous, incapable of any exertion either of 
body or of mind, — his fi.rst feeling is a desire for stimulants, 
with every fresh dose of which he recovers a certain de- 
gree of vigor both of body and mind, till he feels compar- 
atively comfortable. A few hours pass without the craving 
being so strong; but it soon returns, and the patient drinks 
till intoxication is produced. Then succeeds the restless 
sleep, the suffering, the comparative tranquillity, the ex- 
citement, and the state of insensibility; and unless abso- 
lutely secluded from all means of gratifying the propensity, 
the patient continues the same course until he dies or be- 
comes imbecile." 

Dr. John E. Tyler^ in his yearly report for 1866, as super- 
intendent of the McLean Asylum, speaks of the nature of 
of dipsomania, as follows: 

" It sometimes happens that after a fever, or other severe 
illness, or after a fall or blow upon the head, or after a se- 
vere domestic afi3.iction or bereavement, or a sudden loss of 
property, a person always temperate is seized with and 
yields to an impetuous desire to drink ardent spirits. Thus? 



Ohio State Medical Society. 23 

lamented as much by the individual as by his friends, but 
by successive indulgences which he can not refrain from, 
and from which if he is not prevented by others, he reaches 
the sad mental and moral condition of the inebriate. ^ "^ 
Such deserve but do not have sympathy, inasmuch as 
mental disorder precedes and causes the excess." 

Dr. Anstie, in Reynold's System of Medicine, in his ar- 
ticle upon Alcoholism, says: "It is in truth rather a variety 
of constitutional insanity than of alcoholic disease, but as 
their outbreaks owe many of their characteristic symp- 
toms to the influence of drink, the disease requires notice 
in a treatise on alcoholism." 

LeviUe, p. 249, Z>e la Folie des ivrognes, Paris, 1825, pre- 
sents the following upon the nature of dipsomania, and as 
Hufeland's description: 

" Prof. Hufeland gives the following description of dip- 
somania : Unsteadiness of nervous system ; lassitude of the 
members ; various illusions of the external senses ; altered 
sensibility of the optic nerves ; trembling of the hands, and 
great timidity. The disease is consecutive to a first con- 
dition provoked by alcoholic drinks and fixes itself upon 
the abdominal viscera ; there is fever, colic, and disagree- 
able sensations in the abdomen ; that which does not belong 
to deliriuin tremens. Dipsomania is symptomatic, the de- 
lirum which characterizes it is like to that which accom- 
panies certain fevers, and of which the principal cause is 
located in the apparatus of the digestive organs ; it dimin- 
ishes after the ingestion of spiritous liquors and reappears 
when their efiect ceases. Recovery obtains but when vom- 
iting supervenes." Hufeland, in 1819, in his preface to 
Bruhl-Cramer, says of dipsomania, " it has the greatest 
analogy to nymphomania." 

The fact that it is not developed but with those addicted 



24 Dipsomania and Drunkenness. 

to some extent to the use of strong drink allies it closely to 
the more common forms of drunkenness. 

All men do not drink continuously who have a thirst for 
liquor — a great part of all drinkers drink more or less peri- 
odically — Bruhl-Cramer says, Sec. 7: " The moral causes 
appear to operate but when the frequency of previous ex- 
cesses have created a predisposition to dipsomania ; at least 
I have not knowledge of one single case of dipsomania 
where the individual had not before committed excesses 
with strong drink." 

Salvatori says: " The principal predisposing cause is a 
great excitability of the nervous system ; another cause is 
the habit of frequently abusing wine; it is that which en- 
genders the excessive excitability of the nervous system, 
which seems to be the principal element of the disease." 

He does not consider dipsomania as an idiopathic mental 
affection but as a material affection of the body, which re- 
sults in a weakness of intellect and insanity. He says: 

"The disease is located in that part of the nervous sys- 
tem situated in the hypochondriac region, and that which 
we usually designate under the name of the abdominal 
ganghonic system ; dipsomania ought then to be considered 
a^ a species pathologically belonging to the class we call 
common hypochondriacs and hysteria." 

Bruhl-Cramer also declares that it is a disease purely 
physical. To this we assmt, and as we find with the hyster- 
ical and hypochondriacal perverted tastes, so we have with 
dipsomania. With persons of a weak nervous system we 
readily find local disturbance become general in its influ- 
ence. A weak,' unstable nerve-center is always an excitable 
one. The desire is great for something that will suppress 
the unpleasant sensations. The local irritation is followed 
by sympathetic intellectual disturbance. 



Ohio State Medical Society. 25 

Bagonet, Traite des Maladies 3Ientales, p. 288, says of 
delirium tremens: " This form of alienation ought not to be 
confounded with dipsomania, a variety of monomania, 
which is characterized by irresistible tendencies, violent im- 
pulses for drink, and which we will further describe.'^ 

Marce, as we have already seen, regards dipsomania as an 
instinctive monomania. He says, however, p. 387, " We 
designate under the name dipsomania a particular form of 
instinctive monomania^ which consists in an irresistible de- 
sire to drink alcoholic liquor." 

Descuret^ La 3fedecine des Passions, says: "Drunkenness 
is sometimes continuous, but the most often it is intermit- 
tent. It is, in effect, with many individuals, that they are 
intoxicated but in the spring-time — others in the winter — 
some only certain times in a month or week." 

Ksquirol treats of dipsomania as monomania d'ivresse, and 
declares that these individuals are impelled by an irresist- 
ible force into abuse of alcoholic liquors. He says, p. 370, 
Tome I. des Maladies ITentales, after relating illustrative 
cases: " After the preceding facts, who can deny that there 
exists a mental malady of which the character in general is 
an irresistible force compelling the abuse of strong drink?" 

He regards the periodic character as evidence of insanity 
from the fact that the individuals affected, in general, drink 
periodically and have a thirst for drink but when there is a 
predominance of nervous symptoms — when these subside the 
thirst for liquor is gone. 

Morel, Des Mcdadies Mentales, p. 418, thus expresses his 
views of the nature of dipsomania: " That which it is 
proper to say of the irresistible propensity to drink alco- 
holic liquor, can and should be applied to other diseased 
conditions which, with some physicians, form distinct pa- 
thological entities: I wish to speak of the monomanias, 



26 • Dipsomania and Drunkenness. 

suicidal and homicidal, of incendiarism and kleptomania. It 
is also as impossible for me to make a special disease of 
this irresistible force that bears the individual to drink as 
it has been to find a distinct mental affection in that blind 
instinct, in that something indefinable lohich forces certain in- 
dividuals to murder. Suicide, incendiarism, theft, the de- 
praved tendencies for drink and the consequences of it, are 
the facts which the most commonly lead to judicial inves- 
tigations with the insane. ISTow my firm conviction is that 
all these acts are the symptoms of a mental disease of which 
the true pathological characters can be demonstrated." 

Again he says, " It is not necessary to create a special 
form of mental disease, a monomania of which the prin- 
cipal character will be an irresistible tendency to drink." 

Falret, Traite des Maladies Mentales, does not regard dip- 
somania worthy of being ranked as an entity in mental 
diagnosis, nor does he favor the designation of it as a 
monomania. 

Greisinger we quoted, he regards dipsomania as a symp- 
tom rather than as a cause of periodic insanity. 

Dr. Ray speaks of these cases as being the subject of 
vice. After giving cases to illustrate the nature of the 
malady, he says, p. 498, Jurisprudence of Insanity: " These 
phenomena strongly remind us of some of the manifes- 
tations of moral mania, and if further evidence is necessary 
to convince us that they are both connected w^ith similar 
pathological conditions, it is abundantly furnished in some 
other phenomena of drunkenness. It is now well under- 
stood that this vice assumes sometimes 2u j^^viodic character, 
persons indulging in the greatest excesses periodically, who 
are perfectly sober during the intervals which may continue 



Ohio State Medical Society. 27 

from a month to a year. From a state of complete so- 
briety, they suddenly lapse into the most unbounded in- 
dulgence in stimulating drinks, and nothing but absolute 
confinement can restrain them." 

Guy^ Forensic Medicine, p. 171, says of the nature of dip- 
somania: "A craving after spirituous liquors is one ot the 
recognized forms of unsoundness of mind (dipsomania); 
while in others it is merely a leading symptom of a more 
general disorder, in some cases the craving after alcoholic 
liquors is intermittent, showing itself only at intervals." 

By the comparison of views of writers we have made we 
observe that it is clearly established that dipsomania is a 
physical disease; the j^hysical condition one of impaired vi- 
tality, with consequent exaggerated or perverted desires. 
All authors unite in the fact that the all-essential feature of 
the disease is a craving for strong drink. From this we 
infer that the nutritive functions make a demand for some- 
thing that will supply the apparent loss of vitality or give 
impulse to what remains. In our opinion it is but a modi- 
fied and exagerated desire. But what is a desire ? To show 
the relation of the disease in question to a desire in a nor- 
mal state, we must first fully comprehend the relation exist- 
ing between sensation — desire — emotion, and the will. 

Desire is a state of suspense, existing between a motive 
on one band and execution or action on the other. 

Bain, in his Mental Science, defines a desire: "The state 
of mind where there is a motive to act — some pleasure or 
pain, actual or ideal — without the ability." Again, "When 
a pleasure prompts us to work for its continuance or in- 
crease, and when we at once follow the prompting, there is 
no place for desire. "^ "^ In desire, there is the 



28 Dipsomania and Drunkenness, 

presence of some motive, a pleasure or a pain, and a state 
of conflict in itself painful." 

There are various modes of escape from the conflict and 
unrest of desire. 

The first is /orceoJ gMzesce/zce; to which are given the fa- 
miliar names — endurance, resignation, fortitude, patience, 
contentment." With this we may add the remedy is a vol- 
untary one. It requires an exercise of. will power to sup- 
press the impelling force of the desire. The emotion aris- 
ing, that is a sensation giving rise to either pleasure or pain, 
may be neutralized and the impulse to action suppressed. 
The ability to control the emotions and to suppress them 
is an essential element of true greatness — for with this 
power developed to a high degree only can full exercise of 
reason and judgment be obtained. The weak Will yields to 
the demands of appetite, to the appeal of passion, to the 
example and influence of emotion in others. The power 
of the Will in controlling the passions, and the emotions of 
joy and grief, pleasure and pain, is illustrated with the old 
philosophers and in savage life better than elsewhere. 
They show a strange contrast between the mastery of the 
passions and the weak-willed, emotional class of more 
civilized life. 

Uphavi thus pictures it in the savage : " Let the reader 
go with us a moment to yonder dark and boundless forest. 
Behold beneath the light of the uncertain and shuddering 
moon the fire kindled which is destined to consume the 
victim taken in war. View him fastened to the stake, his 
flesh slowly consumed, and, as it is burning torn piece-meal 
from his blackened bones. What inexpressible suffering ! 
And yet this dark son of the forest, this poor, ignorant 
child of nature betrays no weakness of purpose, sheds no 
tears, utters no exclamation of impatience. His enemies 



Ohio State Medical Society, 29 

can take from liim his distant wigwam, his wife and chil- 
dren, his burning body, his expiring life ; but the sudden 
death-song rising loudly and triumphantly is a proof that 
they have not taken, nor are they able to take from him, 
the firm resolve — the unconquerable luill." 

Bain says, "A second outlet for desire is ideal or imagin- 
ary action.'" The desire in question arising from some want 
or deficiency of the system, and having been once sup- 
pressed only by strong drink, the condition thereby ob- 
tained remains in memory, and the condition recurring, is 
a motive to repeat the excesses that desire may be unfelt. 
The vision of strong drink appears — the imagination pic- 
tures it constantly to the mind in pleasing colors, and the 
victim of dipsomania endeavors to drown his sensations in 
the intoxicating draught. 

In man /our main classes of desires may be said to exist, 
arising from the wants of his natural organization, or to 
supply material for the growth of body and mind: 

1. The intellectual. 

2. The moral. 

3. Vegetative functions: Hunger, thirst, respiration, &c. 

4. Reproductive functions. 

These seem to be allied closely in the manner of exhib- 
iting their demands. Either a motive to action is afforded 
through the desire, or an emotional condition results, re- 
quiring the exercise of will-power to restrain it. In a state 
of sanity the will is directed by the motive, subject to the 
sanction of conscience, reason, and judgment. 

In criminal procedure, a man alleged to be insane, and 
consequently irresponsible, must be beyond the infiu- 
ence ot motives, otherwise there is no immunity from pun- 
ishment. Motives must cease to have power over him. 
With great criminals, or hardened and incorrigible, there is 
4 



30 Dipsofnania and Drunkenness. 

a debatable, middle ground between sanity and insanity, in 
which motives have not lost their power, if the attention is 
directed to the consequences of an act. The individual is 
ajp'parently beyond the reach of motives, the censure or ap- 
proval of society no longer influences him, yet he can if he 
sees proper govern his actions. There is a blind, instinct- 
ive impulse directing his actions, yet not beyond his power 
to thwart if self-interest prompts otherwise, or some end 
to be achieved can thereby be gained. In the vortex of 
the whirlpool of passion no ear is open to the voice of con- 
science. In this state of moral weakness deliberation and 
judgment fail to produce mature fruit. On the one hand 
there is an appetite, a desire, — a lust, — on the other, in the 
dim distance, looms up faintly to the unheeded, or unedu- 
cated conscience, with its imperfect ideal of good and evil, 
the path of duty. Emotion, the offspring of sensation, 
antagonizes will. The desire becomes imperative, and the 
will unaccustomed to exercise its executive power untram- 
meled, yields. The individual, if motives do influence himy 
flies to the society and scenes that past experience has 
taught him will absorb his attention, and drown all prompt- 
ings of his better nature. He throws himself a loiUing vic- 
tim into the current that will bear him irresistibly on, until 
he sinks beneath its turbulent surface to rise no more. The 
prayer of conscience is drowned amid the uproar of de- 
bauchery, attention forbids to exercise its office, and all that 
can operate for good is enjoined by this cultivated moral 
apathy to inactivity. Again, where conscience is not suc- 
cessfully stifled but 7vill be heard, the individual pursues his 
way much as did the man who would not rise till noon. 
He delays reformatory action to hear the pleading of desire, 
until procrastination steals the opportunity for any other 
action. The attention divided between good and evil ren- 



Ohio State Medical Society. 31 

ders man powerless to pursue the path of duty. The truth 
can only be found by undiverted, undissipated, unwavermg 
attention in the course of proper pursuit. 

A French author {31alebranche, Traite de Morale,) beau- 
tifully ilhistrates the fact that good actions can spriug only 
from attention^ and this full exercise of attention only from 
a cultivated, regenerated Will. 

" The discovery of truth can only be made by the labor 
of attention; because it is only the labor ot attention which 
has light for its reward; the attention of the intellect is a 
natural prayer by which we obtain the enlightenment ot 
reason. But since the fall, the intellect frequently experi- 
ences appalling droughts; it can not pray; the labor of at- 
tention fatigues and afflicts it. In fact, this labor is at first 
great, and the recompense scanty; while at the same time 
we are unceasingly solicited, pressed, and agitated by the 
imagination and the passions, whose inspiration and im- 
pulses it is always agreeable to obey. ^Nevertheless, it is a 
matter of necessity; we must invoke reason to be enlight- 
ened; there is no other way of obtaining light and intelli- 
gence but by the labor of attention. Faith is a gift of God 
which we earn not by our own merits; but intelligence is a 
gift usually conceded to desert. Faith is a pure gift in 
every sense; but the understanding of a truth is a grace of 
such a character that it must be merited by labor or the 
co-operation of grace. Those, then, who are capable of this 
labor, and who are always attentive to the truth which 
ought to guide them, have a disposition which would un- 
doubtedly deserve a name more magnificent than those 
bestowed on the most splendid virtues. But although this 
habit or this virtue be inseparable from the love of order, 
it is so little known among us that I do not know if we 
have done it the honor of a particular name. May I^ there- 



32 Dipsoma7iia mid Dt'mikenness. 

fore, be pardoned in calling it by the equivocal name of 
force of intellect. To acquire this true force by which the 
intellect supports the labor of attention, it is necessary to 
begin betimes to labor; for in the course of nature, we can 
only acquire habits by acts, and can only strengthen them 
by exercise. But perhaps the only difficulty is to begin. 
We recollect that we began, and that we were obliged to 
leave off. Hence we get discouraged; we think ourselves 
unfit for meditation; we renounce reason. If this be the 
case, whatever we may allege to justify our sloth and neg- 
ligence, we renounce virtue, at least in part. For without 
the labor of attention we shall never comprehend the 
grandeur of religion, the sanctity of morals, the littleness 
of all that is not God, the absurdity of the passions, and of 
all our internal miseries. Without this labor, the soul will 
live in blindness and disorder, because there is naturally no 
other way to obtain the light that should conduct us; we shall 
be eternally under disquietude and in strange embarrass- 
ment, for we fear everything when we walk in darkness 
and are surrounded by precipices. It is true faith that 
guides and supports, but it does so only as it produces some 
light by the attention which it excites in us; for light alone 
is what can assure minds like ours which have so many 
enemies to fear." 

Man's moral power, moral principle, is then dependent 
upon the exercise of an intellectual faculty: attention, and 
attention upon the supreme executive faculty of the mind: 
the Will. Without attention there can be no exercise of the 
other mental faculties. 

The weakened will has been regarded by some as a spe- 
cies of insanity. It is in reality an imbecility dependent 
upon an enfeebled cerebrum. How many criminals have 
their career of crime determined by an inherited feebleness 



Ohio State Medical Society. 33 

of the will. The Coleridges illustrate well this principle 
of imbecility. The elder was an opium eater — the younger 
inherited the condition his parent had by habit acquired. 
Rash, impulsive, his life was a series of failures and bitter 
self-reproaches. In one ot his books he w^rote: 

"Oh! -woful impotence of weak resolve, 
Recorded rashly to the writer's shame, 
Days pass av^ay, and time's large orbs revolve, 
And every day beholds me still the same. 
Till oft-neglected purpose loses aim, 
And hope becomes a flat unheeded lie." 

This is ever the condition of those who inherit a thirst 
for alcoholic liquor. Elam declares that 'Hhe habit of the 
parent, when inherited, does not appear in the child as a 
habit merely, but in most cases as an irresistible impulse, — 
a disease." 

A writer in the Psychological Journal of Winslow, re- 
marks in this language concerning the nature of so strange 
a disease : 

"An impulsive desire for stimulant- drinks, uncontrol- 
lable by any motives that can be addressed to the under- 
standing or conscience, in which, self-interest, self-esteem, 
friendship, love, and religion are appealed to in vain; in 
which the passion for drink is the master passion, and sub- 
dues to itself every other desire and faculty of the soul. 
^ * >K ^\^Q victims of it are often the offspring of per- 
sons who have indulged in stimulants, or who have weak- 
ened the cerebrum by vicious habits or undue mental 
labor." 

3forel presents a clear statement of those who inherit de- 
praved tendencies, and sets forth a correct statement of 
those who inherit dipsomania: 



34 Dipsomafiia a?td Drunkenness. 

^^ Such cases present themselves to our view with the 
predominance of a phenomena of a mental order, which I 
have had occasion to mention — that is, a complete abolition 
of all the moral sentiments. One might say that no distinc- 
tion between good and evil remains in the minds of these 
degraded beings." 

That dipsomania is the result of derangement of nerve- 
element, may be inferred from its tendency to transmission 
by the same laws that govern the various forms of hered- 
itary nervous disorders. It must be allied to gluttony, lib- 
ertinism, nymphomania, and a variety of conditions that 
may be transmitted from parent to child — in their own 
form or one into which that has been metamorphosed. It 
finds its analogue in many diseases of a hereditary char- 
acter. 

As the scrofulous child will devour lime, plastering from 
the walls, or mud from the boots of any one within its 
reach, so the methomaniac craves, and drowns his desires 
in strong drink. It is a physical condition, displaying its 
main features through derangement of the digestive or- 
gans, and consecutively through intellectual disturbance. 
In diseases in which there has been a great drain from the 
system analogous desires exist. Thus, during the war, I 
have observed hundreds of men who had an ungovernable 
appetite for food and drink, who were the victims of chronic 
diarrhea. Digestion, absorption, and assimilation, all 
seemed to be arrested. The body melted down and flowed 
away in the frequent liquid discharges. Here the unsat- 
isfied wants of the vegetative system gave rise often to a 
mental condition — to an apathy or torpor of the intellect- 



Ohio State Medical Society. 35 

ual faculties, in which the patient thought only of food 
and the demands of nature. The brain did not, in many 
cases, sympathize with the local disturbance in the digest- 
ive organs. 

With those suffering from dipsomania there is, on the 
contrary, a condition of the nervous system similar to that 
of hysteria. The nerve-centers are weak, irritable, un- 
stable. This condition of the nervous system is encount- 
ered with the libertine-. In fact, writers use very similar 
language in speaking of the influence of the sexual passion 
over the mind that they do of drunkenness. Most writers 
regard dipsomania as a sequel to intemperate indulgence 
rather than as a spontaneous condition, or as an idiopathic 
disease. 

Bourgeois says of libertinism: "It is to the abuse of 
voluptuous sensations rather than to virtuous abstinence 
that it is necessary to attribute the maladies we have named 
(erotomania, &c); such is the mature opinion of thought- 
ful men, such as Max Simon, Duffieux, Diday, Mayer, 
Briquet, and Fredault, who have furnished indisputable 
proofs." 

Writers have attributed erotomania to continence. Bour- 
geois, p. 118, Les Passions, says, " Seek not to excuse then 
the relaxation of morals, under the pretext of continence 
— that continence is impossible, that it is hurtful. ISTo, this 
is not the physiological demand, it is the desire unrestrain- 
ed, it is the abuse which has forced to bad habits and which 
corrupts the health. The brain has a powerful influence 
upon the, functional activity of the genital organs. The 
s^alacite comes most often from the excitations of a depraved 
imagination." 



36 Dipsommiia and Drunkenness. 

Again, he says of the power of habit in producing the 
condition: ''In these impure connections soon is destroyed 
all mental vigor, soon is thrown to the wind all moral sen- 
timents. % i^ ^ ^^ lensrth the inveterate 
habit of the debauchee can not be broken and you see 
many who remain unmarried that they may continue more 
at their ease their dissolute life." 

Is it not true of the dipsomaniac? He at first experi- 
ences only an increased desire for drink, but yielding to it 
he establishes a habit which eventually becomes so deeply 
rooted that mind alone can not uproot it. 

111. The Mental State. As may be inferred from the 
preceding pages, we regard the disease, dipsomania, as a 
pnrely physical condition, not entitled to the rank of an 
insanity until continued and oft-repeated returns of the 
drinking fits have degenerated the nerve-centers to such an 
extent that the will can no longer repress the desire. The 
intellectual disturbance will, as in fevers, dyspepsia, and all 
diseases giving rise to local abdominal irritation, be ob- 
served to keep pace with the condition of the nerve-centers, 
in relation to their stability or excitability. 

These persons previous to drinking, when the fit comes 
on, appear to be able to fully comprehend their condition, 
to know right from wrong, that their excesses are disgrace- 
ful, yet, as do thieves, murderers, and scoundrels of all 
grades, they persist in their course, deaf to all entreaty, self- 
interest, reputation, or their own safety. There is no want 
of ability to comprehend what is their duty, but a persist- 
ent, absolute determination to drink at all cost — at all haz- 
ard — regardless of all consequences — Will seems subservient 



Ohio State Medical Society. 37 

to the animal. The mental state, during the 'period of so- 
briety, differs in no way from that of other individuals who 
are not habituated to the use of alcoholic liquors — ivhen 
drunk the mental state is similar to that of other drunkards. 
In my opinion the disease is acquired, and even in those 
cases in which the hereditary thirst for drink seems irre- 
sistible, the condition is not developed fully until there has 
been previous indulgence. These repeated indulgences 
produce degenerations. There is in all forms of nervous 
disorders more or less periodic tendency exhibited. In 
common drunkenness there are few individuals who drink 
to any extent, that do not show more or less periodical de- 
sire. As degeneration of nerve-structure of the brain is 
developed, meningeal, gastric, and other irritations induced, 
the disease partaking more and more of the nature of de- 
lirium tremens so is responsibility lessened. While we do 
not dispute that in all countries where drunkenness has 
prevailed through several generations that a physical con- 
dition is acquired, described by writers, and which may be 
transmitted, becoming a desire, an instinctive impulse with 
the child, we do not believe that drunkenness, previous to 
excesses, is wholly involuntary, constituting a psychial entity, 
a special or distinct form of insanity. That is, loe admit the 
existence of a dipsomania, but regard it as a physical con- 
dition. We admit more: that true insanity may be attended 
in its development, among other symptoms, with a nervous 
prostration — exhaustion — that impels the person to use 
immoderately of strong drink. It is theyi a symptom, not the 
disease more than a hot skin or a coated tongue is a bilious 
fever. It should be considered at its true value, as any 



38 Dipsomania and Drunkenness. 

other symptom, indicating a physical state. There are not 
the well marked pathological conditions of delirium tremens^ 
illusions, hallucinations, tremors, and sleeplessness, de- 
pendent on degeneration of nerve-element. If these are 
an element of the case, forming an essential part of the ag- 
gregate of symptoms, we should be inclined to consider the 
case one of pure delirium tremens, and call it by that name. 
If previous excesses determined the condition we should 
then, if the above symptoms were present, have no doubt 
of the true character of the disease. For legal purposes, 
as a defense, it would be well to try to establish this in 
evidence. 

IV. What "tests" shall we apply to determine the degree 
of responsibility f "Knowledge of right and wrongV 
The individual when not too drunk, has as clear a perception 
of duty as do the men who recruit the general class of evil 
doers. They declare positively the right and as positively 
enter upon the contrary. Shall the " irresistible impulse," 
that indefinable something, be the test ? If we admit this 
principle into the Code of Criminal Procedure, making it 
the guide in determining responsibility, where shall we 
place the limit that shall cut it off from vice — from sensu- 
ality — immorality and complete indifference to the rights 
of others. 

The same tests must be applied to all the monomanies — 
the same investigation of causes, conditions, and conse- 
quences that govern the acknowledged or accepted forms 
of insanity. If the condition is one of insanity it does not 
follow as a natural consequence that it relieves from all legal 
responsibility. To determine the existence of insanity is to 
establish one fact — the degree of responsibility is another. 



Ohio State Medical Society. 39 

With delirium tremens there is no room for difference of 
opinion — the law relieves from all responsibility, as we 
shall show. The only test of insanity here required is, that 
the condition be proved to exist. 

The Legal Relations of Drunkenness must be made to 
conform in their application to the more general relations 
of insanity. If voluntarily induced it bears about the 
same relations to crime that do the passions, and in no way 
excuses crime, yet as we shall see by the general course of 
cases, intoxication may be pleaded to show that passion, and 
not premeditation, intent, and malice, ingredients of the 
crime of murder, which if absent reduce the grade of the 
offense, was the motive-power in inducing the crime com- 
mitted. 

The plea of intoxication is admitted more by way of ex- 
planation than of excuse or mitigation. Thus to constitute 
a case of murder at common law the aforementioned in- 
gredients must be proved to exist. The fact to be proved 
then is not whether the party was in a state of intoxi- 
cation, but the state of mind with reference to these ingre- 
dients. It matters not in the final issue whether the party 
be drunk or sober; the question of fact is, whether any of 
the ingredients of the crime are absent. If intoxicated the 
law still presames, in the absence of contrary evidence, 
that the act of killing is willful, deliberate, malicious, and 
premeditated, and the evidence of drunkenness is only ad- 
mitted to explain whether there existed the ingredients of 
murder — premeditation, malice, intent, — at the time the al- 
leged act was committed. If intoxicated, the law still re- 
gards the party to be of sound mind. 



40 Dipsomania and Drunkenness. 

Guy says of drunkenness : " This lias no legal effect on 
any offense to which it leads. It neither increases nor 
mitigates the penalties that attach to it. It has even been 
deemed an aggravation. A drunkard's acts are therefore 
valid, unless it can be shown that the drunkenness was pro- 
cured by another person with a view to an unfair advantage." 

Those whose interest or curiostiy leads them to a further 
examination of the legal relations, will find in the follow- 
ing authorities what they may desire. Their views are 
those accepted by the courts, or the ruling of the Court 
itself. 

" Long-continued inebriety, although resulting in occa- 
sional insanity, does not require proof of a lucid interval 
to give validity to the acts of the drunkard, as is required 
when general insanity is proved. When the indulgence 
has produced general derangement of mind, it would be 
otherwise." — [Gardiner v. Gardiner, 22 Wend. 526. 

" Though voluntary drunkenness can not excuse for the 
commission of crime, yet where, as upon a charge of mur- 
der, the question is, whether an act was premeditated, or 
done only from sudden heat and impulse, the fact of the 
party being intoxicated has been held to be a circumstance 
proper to be taken into consideration." — [So * ruled by 
Holroyd, J., Eex v. Grindley, 1 Russ on Cr., by Grea, 8. 
Repeated in Penn. v. McFall, Addis, 257. 

Delirium Tremens excuses crime. In the case of Dreio 
(U. S. V. Drew), for the murder of Clark, the relations of 
delirium tremens to responsibility are well set forth. The 
evidence before the court, U. S. Circuit Court, May term, 
1828, showed that Drew was of fair character, but addicted 

^' Overruled by Parks and Littledale in Rex v. Carroll, 7, C. & P., 145. 



Ohio State Medical Sodety. 41 

to the excessive use of ardent spirits; After recoverinoj 
from a drunken spree, in August, 1827, he threw all the 
liquor overboard from his ship. In two or three days after, 
he began to exhibit symptoms of an approaching mania a 
'potii — suffered loss of appetite, sleeplessness, hallucinations 
and delusions. One of these was, that an Indian belong- 
ing to the ship was about to kill him, and calling him by 
name he promised to drink no more if he would not kill 
him. In the night of the 31st of August he attempted to 
throw himself overboard, but was prevented. The next 
morning while Drew and Clark were at breakfast, Drew 
left the table suddenly and was observed to conceal some- 
thing under his jacket which was on the transom in 
another part of the cabin. He then turned round and re- 
quested Clark to go upon deck. The latter replied that he 
would as soon as he had finished his breakfast. Drew then 
exclaimed, " Go upon deck or I will help you;" took the 
knife he had covered with his jacket, and saying no more, 
plunged it into the right side of Clark's breast. Clark fell 
but rose again and went upon deck. Drew cocked a pistol, 
pointed it at witness and snapped it; it missed fire. Drew 
followed them on deck, and said to his mate: "Mr. Cofiin, in 
twenty- four hours the ship shall go ashore." 

He was then seized and confined. For some weeks his 
actions were those of one insane. When restored he was 
told that Clark was dead, and he replied that he knew 
nothing about it ; that it appeared to him like a dream; 
that when he awoke he found himself handcuffed, but 
knew no more."^ 



'^ "It is not competent for the prisoner to give in evidence his own account 
of the transaction, related immediately after it happened, even though no 



42 Dipsoma7tia and Drunkenness. 

After the above evidence, Justice Story gave as an opin- 
ion that the indictment could not be maintained, because 
the prisoner was beyond doubt insane when the offense was 
committed. He added : 

"The question made at the bar is, whether insanity, 
whose remote cause is habitual drunkenness, is or is not 
an excuse in a court of law, for a honiicide committed by 
the party while so insane, but not at the time intoxicated or 
under the influence of liquor. We are clearly of opinion 
that insanity is a competent excuse in such a case. In gen- 
eral, insanity is an excuse for any crime, because the party 
has not the possession of his reason, which includes respon- 
sibility. An exception is, when the crime is committed 
while the party is in a fit of intoxication, and while it lasts; 
and not, as in this case, a remote consequence, superinduced 
by the antecedent exhaustion of the party arising from 
gross and habitual drunkenness. 

"However criminal, in a moral point of view, such an in- 
dulgence is, and however justly a party may be responsible 
for his acts arising from it to Almighty God, human tribu- 
nals are generally restricted from punishing them, since 
they are not the acts of a reasonable being. Had the crime 
been committed when Drew was in a fit of intoxication, he 
would have been liable to be convicted of murder. As he 
was not then intoxicated but merely insane from an absti- 
nence from liquor, he can not be pronounced guilty of the 
offense. The law looks to the immediate and not the re- 
mote cause, to the actual state of the party, and not to the 
cause which remotely produced it. Many species of insan- 

person was present at the occurrence; for his account of it was no part of 
the res gestae.^' Greanleaf Ev., Sect, 149, and also State v. Tilly, 3 Ired. 424. 



Ohio State Medical Society, 43 

ity arise remotely from what in a moral point of view is a 
criminal neglect or fault of the party — as from religious 
melancholy, undue exposure, extravagant pride, ambition, 
&c; yet such insanity has always been deemed a sufficient 
excuse for any crime done under its iniluence." — [5 Mason, 
28.] The man was acquitted. 

Concerning intent, premeditation, and malice as ingre- 
dients of the crime of murder, as to whether they are re- 
moved by intoxication, the following opinions and rulings 
in leading cases by the presiding judges may be presented. 

It was held that " intoxication, when existing to a suf- 
ficient extent to prevent deliberation, lowers the oflense to 
the second degree." — [Com. v. Jones, 1 Leigh, 612; Com. v. 
Haggerty, Lewis, C. L., 403; Pirtle v. State, 9 Humph, 664. 
Competent authority declares the opinions in these cases 
not law; some are overruled. 

Judge Lewis, C. L., 405, says, " Except in the case of 
murder, which happens in consequence of actual or at- 
tempted arson, rape, robbery, or burglary, a deliberate in- 
tention to kill is the essential feature of murder in the first 
degree. When this ingredient is absent, where the mind, 
from intoxication or any other cause, is deprived of its 
power to form a design with deliberation and premedita- 
tion, the ofiense is stripped of the malignant features re- 
quired by the statute to place it on the list of capital crimes; 
and neither courts nor juries can lawfully dispense with 
what the act of the assembly requires." (Penn. Statutes 
governed the opinion.) 

In a case in Tennessee, Green, judge, said: "Voluntary 
intoxication is no excuse for the commission of crime ; on 



44 Dipsomania a7id Drunkenness. 

the contrary, it is considered by our law as an aggravation 
of it *; yet if the defendant was so deeply intoxicated by 
spirituous liquors at the time of the killing, as to be in- 
capable of forming in his mind a design deliberately and 
premeditatedly to do the act, the killing under such a state 
of intoxication would only be murder in the second 
degree." 

Judge Reese, who delivered the opinion of the court in 
the case of Swan v. the State, 4 Hump. K. 136, said : "But 
although drunkenness in point of law constitutes no excuse 
or justification for crime, still, when the nature and essence 
of a crime is made to depend by law upon the peculiar state 
and condition of the criminal's mind at the time, and with 
reference to the act done, drunkenness, as a matter of fact, 
affecting such state and condition of the mind, is a proper 
subject for consideration and inquiry by the jury. The 
question in such case is. What is the mental status ? Is it 
one of self-possession, favorable to a fixed purpose, by de- 
liberation and premeditation, or did the act spring from ex- 
isting passion, excited b^ inadequate provocation, acting, it 
may be, on a peculiar temperament, or upon one already ex- 
cited by ardent spirits .^ In such case it matters not that 
the provocation was inadequate, or the spirits voluntarily 
drank; the question is. Did the act proceed from sudden 
passion, or from deliberation or premeditation ^ What was 
the mental status at the time of the act, and with reference 
to the act? To regard the fact of intoxication as meriting 
consideration in such a case, it is not to hold that drunk- 
enness will excuse crime, but to inquire whether the very 
crime which the law defines and punishes has been in point 
of fact committed." 



*Held to be an error by the supreme court, and decision reversed ; Halile 
V. State, 11 Humph., 154. [See further in this paper the case noticed.] 



Ohio State Medical Society. 45 

In this, the design of the court was not to indicate to the 
jury the fact that a party under the influence of liquor to 
such a degree that he could form no purpose of mind would 
be absolutely incapable of exercising deliberation and pre- 
meditation, but that if deliberation and premeditation were 
established, as an element of the case, drunkenness would 
not affect the issue. 

Judge Turley, who gave the opinion of the court in the 
caseof Pirtle v. the State, said: "It will frequently happen 
necessarily, when the killing is of such a character as the 
common law designates as murder, and it has not been per- 
petrated by means of poison, or by laying in wait, that it 
will be a vexed question whether the killing has been the 
result of sudden passion, produced by a cause inadequate to 
mitigate it to manslaughter, but still sufficient to mitigate 
it to murder in the second degree, if it be really the true 
cause of the excitement, or whether it has been the result 
of premeditation and deliberation; and in all such cases 
whatever fact is able to cast light upon the mental status 
of the offender is legitimate proof: and among others, the 
fact that he was at the time drunk; not that this will ex- 
cuse or mitigate the offense, if it were done willfully, delib- 
erately, maliciously, and premeditately; (which it might 
well be, though the perpetrator was drunk at the time,) but 
to show that the killing did not spring from a premeditated 
purpose, but to sudden passion, excited by inadequate prov- 
ocation, such as might be reasonably expected to arouse 
sudden passion and heat, to the point of taking life, with- 
out premeditation and deliberation." 

" Mere intoxication is no excuse for crime. Evidence of 
it may be admissible to the question of malice." — [Kelly v. 
the State, 3 Smedes & Marshal, 518. 

Further upon intent and malice-. The State v. Cross, 27 
5 



46 Dipsomania and Dnmkenness. , 

Missouri, 332; Golden v. the State, 22 Georgia, 527; the 
same, Jones v. the State, 29, 594; Moonej v. the State, 33 
Alabama, 419; O'Herrin v. flie State, 14 Indiana, 420; 
Dawson v. the State, 16 Indiana, 428. 

In Eex V. Day, 3 Paris & Fonbl. Med. J. 140., it was 
held, "intoxication is no excuse for crime," and the defend- 
ant, who in a paroxysm of drunkenness rose in the middle 
of the night and cut the throats of his father and mother, 
ravished the servant-maid in her sleep and aferwards mur- 
dered her, was executed for these crimes. 

"If a person while sane and responsible makes himself 
intoxicated, and while in that condition commits murder 
by reason of insanity, which was one of the consequences 
of intoxication and one of the attendants on that state, he 
is responsible." — [United States v. McGrue, 1 Curtis C. C. 
I; also the People v. Robinson, 2 Parker C. R., 235; the 
People V. Hamill, same Rep. 223; the State v. Harlowe, 21 
Missouri, 446; Com. v. Hawkins, 3 Gray, 463; Mercer v. 
the State, 17 Georgia, 146; Carter v. the State, 12 Texas, 
500; the People v. WiUey, 2 Parker C. R., 19. 

As to delirium tremens, " State v. Sewall, 3 Jones' Law, 
245; the People v. McCann, 3 Parker C. R., 272; Mac- 
conehey v. the State, 5 Ohio, 77. 

From all these cases, what are we to conclude ? With 
Roscoe, Criminal Evidence page 909, Wharton, Cr. Law, 
3d Ed., 92, and the multitude of other authorities, shall 
we say, "Intoxication is no defense as to the fact of guilt?" 
Shall we say with the old English writer, " A drunkard who 
is voluntarius demo, hath no privilege thereby, whatever ill 
or hurt he doth, his drunkenness doth aggravate it." (Coke's 
Littleton, 46). We believe the views of Guy are sustained 
in the most recent American cases. They have been allowed 
to pursue their way, the question of drunkenness having 
no bearing upon the final issue, — and upon just grounds. 



Ohio State Medical Society. 47 

In the case, Cornwall v. the State of Tennessee, Mar. & 
Ser., 147, 1849, the point is well set forth : 

"A contrary doctrine ought to be forced out of circu- 
lation, if it has obtained it, by every friend to virtue, peace, 
quietness, and good government. All civilized govern- 
ments must punish the culprit who relies on so untenable a 
defense; and in doing so, they preach a louder lesson of 
morality to all those who are addicted to intoxication, and 
to parents and guardians, and to youth and to society, than 
comes with cold abstract from pulpits. To the justice and 
correctness of these remarks, all who have had experience 
in the annals of crime can bear testimony. It is only at 
the present term of the court that we have seen it proved 
that an oifender, a short time before the perpetration of a 
horrid murder, inquired of a grocery keeper what kind of 
liquor w^ould make him drunk soonest, and swallowed 
thereon a bumper of brandy. We have had three cases of 
murder, and one of an assault with intent to murder, before 
us at this term of court, in every one of which there are 
convictions in the circuit court and affirmances in this; 
every one of which is of aggravated character, and in every 
one of which the perpetrator, at the time of the commis- 
sion of the oflense, was laboring under dementia affedata, 
drunkenness; an awful illustration of the necessity of hold- 
ing to the law as it has been adjudged upon this subject. 
There is, in our judgment, no conflict of authority upon 
this point of law; every case which may have such appear- 
ance, being a case of exception on the application of the 
rule, or a case of no authoritj^ upon the subject." 

The same is held in Kelly v. State, 8 Smedes & Marshal, 
518, in which case the question was of intent. The Court 
of Error and Appeals (Miss.) laid down the law, as being 
well established, that drunkenness is no excuse for crime, 



48 Dipsomania and Drunkenness. 

although sometimes held proper for consideration, where 
the sole question is whether the act done was premeditated 
or done only w^ith sudden heat or impulse, which might be 
as truly said of anger or any other excitement arising from 
sudden provocation or peculiar cirumstances ; but not much 
importance was attached to it, as might be conceived from 
the presumption which was equally great, that the design 
might have previously existed, and intoxication have been 
employed to nerve the criminal to the commission of the 
crime; that the law discriminates between the delusion of 
intoxication and the insanity which it may ultimately pro- 
duce. 

If drunkenness, they said, was to be considered an excuse 
for crime, there would be established a complete emancipa- 
tion from criminal justice. — [Wharton in W. & S., Sect. 93. 

We may conclude then that the difference of opinion be- 
tween jurists is rather upon the rule of law governing the 
evidence than upon the legal relation of the crime. Thus, 
if alleged that premeditation, intent, and malice existed, 
and a doubt arose as to whether the act done was the result 
of a deliberate purpose, the best authorities do not admit that 
proof is admissable of drunkenness, that, taken in connec- 
tion with all the other facts and circumstances, the jury can 
determine whether the case is one of murder in the first or 
second degree.* If all the ingredients of murder in the first 
degree exist previous to the killing, except the act itself, as 
intent, premeditation, malice, then drunkenness, however 
great, will not be admitted as a plea that the defendant was 
too drunk to entertain them. These ingredients are ques- 
tions oifact, and as any other fact, are subjects of legitimate 

*An article I have written for the Lancet and Observer (published by E. B. 
Stevens, M. D., 319, Elm Street, Cincinnati, Ohio,) contains a clear statement 
of this question, with authorities upon it. 



Ohio State Medical Society. 49 

inquiry; the circumstances, manner of killing, and evidence 
from other sources, must all go to the jury together, leav- 
ing them to determine the degree of guilt, after having de- 
termined these facts. 

In Ilalile v. State, 11 Humph., 154, it is said: ^' Any. fact 
that will shed light upon this subject ma\^ be looked to by 
them (the jury), and ma}^ constitute legitimate proof for 
their consideration. And among other facts, any state of 
drunkenness being proved, it is a legitimate subject of in- 
quiry, as to what influence such intoxication might have 
had upon the mind of the offender in the perpetration of 
the deed. We know that an intoxicated man will often, 
upon a slight provocation, have his passions excited and 
rashly perpetrate a criminal act. ISTow, it is unphilo&oph- 
ical for us to assume that such a man would in the given 
case be chargeable with the same degree of premeditation 
and deliberation, that we would ascribe to a sober man, 
perpetrating the same act upon a like provocation. It is 
in this view of the question, that this court held, in Swan's 
case, and in Pirtle's case, that the drunkenness of a party 
might be looked to by the jury, w^ith the other facts in the 
case, to enable them to decide whether the killing was 
done deliberately and premeditatedly. But his Honor, the 
circuit judge, told the jury that drunkenness was an ag- 
gravation of the offense, unless the defendent w^as so deep- 
ly intoxicated as to be incapable of forming in his mind a 
design deliberately and premeditatedly to do the act. In 
this charge there is error, for which the judgment must be 
reversed. Reverse the judgment and remand the case for 
another trial." 

We ought not to close this paper without a direct state- 
ment of the relations of dipsomania to common drunken- 
ness, before the law. Of the works upon criminal law 



50 Dipsomania and Drunkenness. 

Alison* presents the clearest views upon the subject. They 
are, that the law makes no distinction between dipsomania 
and the various states of ordinary drunkenness. Juries do 
sometimes make such distinctions in their verdicts. He 
reports cases. 

ToyloT adds to this, that if drunkenness were admitted as 
an excuse for crime three fourths of the crimes committed 
would go unpunished. 

The general tenor of cases is that dipsomania does not 
exculpate more than common drunkenness ; that it is the 
result of habitual indulgence, and that the greatest differ- 
ence between dipsomaniacs and common drunkards is, that 
they are impelled to drink from different degrees of strength 
of the desire. Both have a thirst for drink, and both when 
it is encouraged attain to a point beyond which retreat is 
impossible. 

The dipsomaniac, if relieved from all legal obligation and 
restraint, would open the door to all grades of offenders 
who stand upon the middle ground between insanity and 
crime. The fact that true dipsomaniacs in their sober mo- 
ments take measures, as the fit approaches, to seclude 
themselves and otherwise protect others from annoyance 
and injury, in a great majority of cases, shows that they 
abandon themselves to their passion, when it is established 
as the libertine, the gambler, and other victims of " moral 
mania^^ (?) do to their impulses. 

With this we close our article. We regret that we al- 
lowed ourself to delay the preparation of it until three or 
four days before the meeting of the society. Much of this 
time was occupied with our practice, leaving too little time 
to digest and put in a desirable shape the matter we desired 

^Criminal Law of Scotland. 



Ohio State Medical Society. 51 

to present. Our object has been to give an outline of tbe 
literature of the subject, rather than a discussion of the 
true principles involved — or the ground of our own opin- 
ions. In our paper upon monoraania we shall aim to dis- 
cuss the grounds for the views, pro and co?i, of the subject, 
rather than the literature of the subject, but will present 
briefly the views of authors, that our paper may represent 
the subject clearly, and not seem based wholly upon our 
own opinions. 

In this paper, lengthy as it may be, and to those versed 
in the subject, we hope, without being prolix, we have es- 
tablished: 

1st. That there is a dipsomania. 

2d. That the condition is sl physical one, 

3d. That the symptoms are so unvarying that all authors 
agree in their description of them; and that authors use 
nearly the identical language in describing the condition, 
that was used from 1817, to 1825, when the disease was first 
pointed out. 

4th. That the law makes no distinction between the re- 
lation of the dipsomaniac and the common drunkard, to 
full legal responsibility. 

We hope those whose interests prompt them to study 
the subject will find fully represented the classic writers 
extant. 

Of the German: Hofibauer, Casper, Bruhl-Cramer, 
Griesinger, Salvatori, Erdman, Fuchs, &c. 

Of the French : Falret, Dagonet, Morel, Marc, Marce, 
Tardieu, Esquirol, &c. 

Of the English and American: Winslow, Tuke, Hutch- 
inson, Ray, Wharton, Story, Taylor, &c. We have not had 



52 Dipsomania and Drunkenness. 

time to consult the various works upon evidence and crim- 
inal practice, with the view of presenting their opinions 
upon the points of evidence, as the taking into consideration 
the state of intoxication^ but preferred to take from our notes 
made from state Reports, the opinions given in leading 
cases in which this view was presented by the court. We 
have given these "pro and con. It will be seen by the foot- 
notes, that the opinions of the first were overruled, not be- 
ing regarded as law. In our work upon Medico-Legal 
Criminal Procedure we will give a reference to all cases 
contained in the State Reports, for and against the con- 
sideration of the evidence in question, so that those hav- 
ing occasion to refer to them can readily do so, if they 
have access to the Reports. In all cases tried in 1873, we 
have noticed the court has ruled with Alderson, in Rex. v. 
Meakin, 7 C. & P., 297: "drunkenness can have no effect on 
the consideration of the WMlicious intent of the party; and in 
the same case, " If a man chooses to get drunk it is his own 
voluntary act. ^ >i< >i^ That voluntary species of mad- 
ness which it is in a party's power to abstain from, he must 
answer for." And also in Rex v. Carrol, 7 C. & P., 145, in 
which Parks overruled the precedent established in Rex v. 
Grinley, by Holroyd's ruling. 



UNITED BRETHREN PUBLISHING HOUSE, DAYTON, OHIO. 



THE 



Course of Lectures i^^^-s 

By D. a. morse, M.D., 



:R U=r&^" LEGAL MEDICINE AND INSANITY. 



J FCTTTRFl 



[Candidates for the Degree of Doctor of Medicine will he examined 
upon this Course.) 



SUBJECT. 

No, 

1. The Medical Expert,— D&f^n\i\on of Medical Juris- 
PRTJDEXCE ; its application. Who are exper^ts, or skilled witnesses ? 
"Opinions" distinguished from "Evidence." Duties, privileges, 
secrets, fees. 

2. JIalpf'actice. — Who are Physicians or Surgeons? Their 
legal responsibilities. Contract — Express or implied. When no 
express contract is made "must render with due diligence and 
attention ordinary sJcill.^' What constitutes " ordinary skill ? " 
Implied Contract : cannot be held as having warranted a cure, or 
in surgery perfect results. Amputations, fractures, dislocations — 
usual results. Negligence. 

3. The Passions. — Kelation to Insanity — metaphysical and 
physiological elements. Exaggerated passions — ambition, pride, 
envy, jealousy, anger, revenge, grief, shame, remorse, &c. 

4. General observations upon the nature and pathology of the so- 
called Functional Nervous Disorders — Chorea, Hysteria, Epilepsy, 
&c. Legal relations. 

5. JMEental Derangements, — The proper " method " — meta- 
physical versus physiological — of studying the mind. 

6. Definition, classification, diagnosis of insanity. Thorough 
knowledge of the Sources of Evidence of insanity as important to 
the general practitioner as to the alienist or expert. Difficulty arises 
and apparent contradiction of experts, in point of diagnosis, from 
considering irresponsibility, a consequence of insanity, as identical 
with the question of insanity. Sources of evidence of insanity: 
Heredite; education; habits; religious influences; previous disease; 
physical organization : form, hands, feet, features ; state of nervous 
system: anaesthesia, hyperesthesia; sensorial functions — illusions. 



hallucinations ; pupil of the eye ; taste ; digestion ; metaphysical 
considerations : desires, affections and passions ; perversion of moral 
nature; will, attention, memory, judgment ; periodicity: is there 
irritability, excitement, depression or stupor, alternating with other 
conditions; temperature of body; pulse; skin, 

7. Same subject continued. 

8. JPathology of l7isanify, — Must be studied before its legal 
consequences can be comprehended. 

9. Varieties of Insanity, — 1. Congenital defects. 2. Ac- 
quired. 

10. Legal JRelations of Insanity. — Relation of organiza- 
tion to responsibility ; moral liberty dependant on development and 
integrity of nerve-centres. Is there a monomania ? Instinctive, im- 
pulsive, reasoning mania? Can there be idiocy of man's moral as 
of his intellectual faculties ? 

11. Crime versus Insanity. — Depravity vs. moral insanity. 
What degree of mental development — what condition or ideal 
standard of mental organization, constitutes mental soundness with 
full responsibility for acts performed ? When this ideal, or given 
standard of mental capacity determines full legal responsibility, 
what must be wanting, what less than this assumed standard of 
capacity can incapacitate for criminal acts ? 

12. Insanity, — Wills, contracts, management of estates, ability 
to testify as witnesses, &c. 

13. Persons Found Dead, — What to observe; signs of 
death.; post-mortem examination. 

14. TFounds, — Definition. What to observe. 

15. Death from drowning, hanging, strangulation, suffocation, 
cold, and starvation. 

16. Suicide, — Evidence of suicide; is it a species of insanity? 
Legal relations. 

17. JSomicide, — Proof of corpus delicti, that a crime was com- 
mitted. What constitutes a crime? Ingredients: malice, intent, 
premeditation. Whsit may he presmned ? Burden of proof ; in- 
sanity must be proved beyond a reasonable doubt ; if not so proved 
prisoner must have benefit of such doubt ; opinions to the contrary. 

18. Rape. — What constitutes rape ; sources of evidence. 

19. Pregnancy, — Signs, duration, delivery. 

20. Infanticide; Criminal Abortion; Concealment 
of Birth. 

Poisons : definition, classification, sources of evidence in alleged 
poisoning, and the more common forms discussed at such length to 
complete the course as circumstances justify and the wants of the 
class require. 



LIST OF PRINCIPAL AUTHORS 



CONSULTED IN THE PREPARATION OF THE PRECEDING LECTURES. 



All of the Foreign Works mentioned have been furnished^ with 
but few exceptions^ by the house of 

LINDSAY & BLAKISTON, 

Publishers, Booksellers, and Importers of Foreign 
Medical Books, 

25 SOUTH SIXTH ST., PHILADELPHIA, PA. 



Devergie, Medecine Legale, . 

Briande et Chaude, Med. Legale 

Taylor, Med. Jurisprudence, . 

Guy's Forensic Medicine, 

Dean, Med. Jurisprudence, , 

Beck, " " 

Orfila, Medecine Legale 

Mahon, " " 

Fodere, " " 

Bayard, " " 

Wharton and Still e, Med. Jurisprudence, 

Casper, Medecine Legale — Gerichtl. Med., 

Bocker, Lehrbuch der Gerichtliclien Med., 

♦* Memoranda, " " *' 

Bergman, Lehrbucli et Med. Forensis, . 
Friedricli, Handbuch — Gerichtl. Pyschol., &c 
Henke, Handbuch der Gerichtl. Med., . 
Krahmer, " " " " 

Meckel, Mende, Nicolai, Schurmayer, works, 
Siebold, Lehrbuch der Gerichtl. Med., . 
Wald, Gerichtl. Med., .... 
Ordronaux, Jurisprudence of Medicine, . 
Chitty, Medical Jurisprudence, 
Trebuchet, Juris, de la Med., . 



^o\i 



Paris and Fonblanque, Med. Jurisprudence, 

Taylor on Poisons, . 

Christison, " 

Otto, " 

Duriau, Strychnia, . 

Orfila, Tra^ite de Toxicologic, 
'' Elements de Chemie, 
" Lecons de Toxicologic, 

Galtier, Toxicologic Generalc and Spec, 

Hillairet, I'Empoisonnement par 1 'arsenic, 

Imbert, par I'Arsenic, .... 

Hardy, Effets Toxicologique, . 

Keveil, Progres de la Toxicologie, . 

"Wormley, Poisons, Micro-chemistry, 

Tardieu, Etude ^^' sur I'empoisonnement, 

Barse, Toxicologie Man. de la Cour d'Assizes, 

Poilroux, de Med. Legale criminelle, 

Alibert, Physiol, ces Passions, 

Descuret, Medecine des Passions, 

Bourgeois, Les Passions, . 

Letourneau, Physiol, des Passions, . 

Lucas, Traite **Heredite, 

Yoisin, Etudes sur la nature de I'homme, 
" Causes of Insanity, 

Collineau, Analyse de I'entenderment, 

Luys, Maladies Hereditaire, 

Beaussire, Liberte dans le ordre, &c., 

Morel, Medecine Legale des Alienes, 

Eegnault, Competence des Me.decins, 

Etoc-Demazy, Suicide, 

Lisle, Du Suicide, .... 

Cazauvieilh, Du Suicide, . 

Bertrand, Du Suicide, 

Brierre de Boismont, Du Suicide, 
" " Hallucinations, 

" " Perversion des Faculties 

Thulie, Folic Avant la Loi, 

Ferrand, Etudes sur la Mort, 

Bichat, Sur la Vie et la Mort, 

Josat, De la Mort, . 

Bouchut, Signes de la Mort, 

Yigne, Mort apparante, . 

Julia de Fontenelle, Signes de Mort 

Goubert, I'Art des Autopsies, . 



Macario, Du Sommeil, 

Lemoine, Du Sommeil, . 

Hammond, Sleep, 

Bergeret, Abus des Boissons, 

Eacle, Alcoolisme, . 

Fregier, Classes dangereuses, 

Voisin, Etat mentale dans I'Alcoolisme, 

Audhoui, Pathol, gen. de I'Empoisonnementpar I'Alcool 

Godfrin, De I'Alcool, 

Magnan, Sur I'Alcool, 

Issartier, De I'Alcoolisme, 

Yerneuil, Les Alcooliques, 

Hebert, Des Alcools, 

Pennetier, De la Gastrite dans I'Alcoolisme 

Voisin, Etat mentale dans I'Alcoolisme, . 

Jolly, L'Alcool, 

Contesse, Etudes sur I'Alcoolisme, 

Morel, Degeneracies, 

Key, " . . 

Esquirol, Maladies mentales, . 

Dagonet, " " 

Marc, " " 

Marce " " 

Ealret, '* " 

Morel, " " 

Pine], " " 

Guislain, " " 

Calmeil, " " 

Greisinger, " " 

Georget, " '■ different work's, 

Foville, Monomania, 

Pinel, " 

Ealret, De la Eolie raisonnante, 

" Hypochondrie, 

" Etat des Epileptiques, . 

" Alienes dangereuse, 

" Eesponsibility des Alienes 

" Eolie paralytique, 
Mandon, Histoire de la Folie, . 
Bonnet, Sur la Monomanie, 
Ollivier, Moral Pathologic, 
Eay, Jurisprudence of Insanity, 
Mayo, Medical Evidence in Insanity, 
Prichard, Insanity, .... 



vol. 



6 



Wigan, Insanity, ... j, .... 1 vol. 
Haslam, " ........ 1 <« 

Maudsley, Mental Pathology, . 
Bucknill, Responsibility of Insane, 
Bucknill and Tuke, Insanity, , 
Winslow, Medico-Legal Evidence, 
TJpliam, Disordered Mental Action, 
Herpin, Epilepsie, .... 
Hoffbauer, Medicine Legale des Alienes, 
A number of works upon the effects of Alcohol, Drunken- 
ness, &c., as Magnus Huss, Carpenter, Miller, &c. 
Tardieu, L'Affair Armand, 

" Etude I'Avortement, . 

" Manuel de Pathologic, 

*' Infanticide, 

" Attentat aux Moeurs, 
Michea, Hallucinations, . 
Baillarger, " . . 

Calnieil, Maladies Inflam. du Cerveau, 

" De la Paralysie, 
Yingtrenier, Alienes des Prisonniers ; 

Lauvergne, Les Forcats, 
On Metaphysics: Locke, Brown, Reid, Steward, Mills, Bain, 
Porter, Spencer, Laycock, Hamilton, Edwards on the Will, 
Tappan, "Whedon, &c., &c., &c. 



Ferrus, Des Prisonniers ; 



{IN PREPARATION.) 
MOESE'S 

MEDIOO-LEGAL CEIMINAL PROCEDURE: 

THE LAW, EVIDENCE, AND PKACTICE. 



MEDICAL JURISPRUDENCE REDUCED TO PRACTICE. 



Entered according to Act of Congress, in the year 1872, by D. A. Moese, M.D., in 
the office of the Librarian of Congress, at "Washington, D. C. 



The Author has found a great demand existing, in both the 
legal and medical world, for a work that will contain, in one 
volume, the Law relating to Experts, the Rules of Law governing 
the Production of Evidence, the Inception of Criminal Cases, 
Eorms, &c. 

This he aims to present in his work upon Medico-Legal Criminal 
Procedure. Everything relating to the subject of Medical Juris- 
prudence, as usually taught in books, will be considered ; but more 
especially will be the objiCct of the work to give a full consideration 
of all subjects that may become questions of legal importance in 
criminal investigations. The work is designed to meet, as a text- 
book, the wants of the medical student, as well as of the practi- 
tioner, the lawyer, coroner, justice of the peace, grandjuryman, &c. 

The Author has observed in many coroners' investigations, or 
preliminary examinations before justices, where death from violence 
is suspected or alleged, that the true cause of death is not deter- 
mined. 

This is generally due to one of two causes : the incompetency of 
those who conduct the post-inortem examination ; or the inability 
of those conducting the examination of witnesses so to frame ques- 
tions that the truth will be elicited. 

To meet the wants of all who require, the art of conducting 
post-mortem examinations — appearances after death — post-mortem 
changes — and the changes wrought by disease, in organs, to be dis- 
tinguished from those resulting from violence, will be considered 
at considerable length — showing what should be observed in 



8 



any given case. One chapter will be devoted to questions^ these 
serving a double purpose — aiding in the study of the work, as well 
as facilitating the examination of witnesses by furnishing sugges- 
tions. 

In the preparation of this work many legal gentlemen of ability 
and acknowledged authority have been consulted, their views have 
been desired, and the author has aimed to square every mooted 
point by direct comparison with them, as well as by standard 
written authorities. The aim of the book is, as its title expresses, 
to render everything practical, to present on all points the law, 
the EVIDENCE, and practice relating thereto. 

In addition to the works previously cited. State Eeports, Files 
of Journals, Annales d'Hygiene Publique et de Medecine Legale, 
the various "Dictionnaires," Archiv fiir Psychiatric und Nerven- 
krankheiten, and many Monographs, Dissertationes, works found 
in the State Libraries at Indianapolis, Columbus, &c., &c., the 
"Work announced above will also be based upon the following 
Authors : 



Roscoe's Criminal Evidence, . 
Burrill's Circumstantial Evidence, . 
Wills' " " 

Appleton on Evidence, 
Wharton's American Law of Homicide, 
Wharton's Criminal Law, 
Allison's " " of Scotland, 

Burnett's " " " 

Hume's " " " 

Archibold's Crim, Pract. and Evidence, 
Bennett and Heard's Leading Crim. Cases, 
Thacker's '' " " 

Wheeler's " - " " 

Chandler's " " " 

Howell's State Trials, " " 

Hale's Crown Pleas, " " 

Davis' Crim. Justice, .... 
Bicknell's Crim. Procedure in Indiana, . 
Wharton's Precedents of Indictments, . 
Train and Heard's Precedents of Indictments 

Beccaria on Crimes, 

Russell on Crimes, . . , . . 
Bishop's Crim. Law, .... 

Bishop's Crim. Procedure, 
Colby's New York Crim. Procedure, 
Dearsley's Crim. Process, 
Chitty's Crim. Law, .... 

Bassett's Crim. Pract. and Pleading, 
Warren, Swann, Crocker, Edwards, Bell, &c., on Forms, &c., &c. 
Halstead, Powell, Phillips, Phillips and Amos, Starkie, Bentham, 
Greenleaf, &c., on Evidence. 



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